Dr. Sharon Lambert:

Today, I want to discuss briefly the powerful but often overlooked concept of intergenerational trauma. This refers to the transmission of the effects of trauma from one generation to the next, not just through stories or memories but also through behaviours, relationships and biology. Any discussion on trauma must first seek to understand what we mean by psychological trauma. The term is defined differently across disciplines. There are narrow definitions that situate trauma as exposure to actual or threatened death, serious injury or sexual violence, and there are broader definitions that imply trauma also includes emotional abuse, neglect, systemic oppression, racism and poverty. Our understanding of trauma has expanded with advances in research, and there is increasing evidence that toxic stressors are experienced as traumatic by many people. There are biopsychosocial impacts of trauma. Biological impacts relate to potential epigenetic changes that alter gene expression patterns without changing DNA sequences directly. Such alterations often involve stress-regulatory genes, with the potential to add to an individual’s children’s vulnerability to stress, anxiety or trauma-related disorders. Psychological issues relate to unresolved challenges passed on to the next generations, including relationship and communication difficulties. Social effects can be seen in the cycles of exclusion, poverty and other social challenges.

Psychological trauma can happen to anyone. It is reported that at least 50% of adults have experienced at least one episode of adversity during childhood, with 6% having experienced four or more childhood traumas. Intergenerational trauma is the transmission of trauma across generations. Traumatic experiences can be passed down through behaviour and parenting practices, leading to persistent trauma impacts across generations. There are those who have more than their fair share of adversity, such as people experiencing homelessness, people with substance dependence, those with criminal justice contact and other groups who face social exclusion due to poverty or ethnicity.

Community-based traumas are related to those communities that often experience an intersection of adversities, such as social exclusion, poverty and discrimination or exposure to political violence. In regard to the latter, consider the experiences of communities in the north of Ireland, Syria and Palestine. Socially excluded groups such as indigenous communities, ethnic groups, LGBT groups and working-class communities experience what are often termed as adverse community experiences, which have been linked to increases in individual adverse experiences. There are many reasons community-level adversity causes interpersonal difficulties. For example, experiences of racism, poverty and classism have an impact on mental health, and this might increase substance dependence, which in turn can have an impact on parenting.

Instances of this double jeopardy of adversity can be seen within most indigenous groups around the world. In Ireland, the Traveller community experiences the highest levels of discrimination in education, employment, housing and justice. This has a direct impact on Travellers’ health and well-being, with a subsequent risk of individual-level trauma, such as death by suicide.

Losing a parent or other family member to suicide may be experienced as a trauma. Within the Traveller community, sudden and traumatic deaths are more common than in the settled community, leading to more complex grief reactions. Similar patterns of multiple-level adversity are seen across various ethnic groups around the world, such as the Mori, Australian Aborigines and Native Americans.

The effects of trauma are not deterministic, though. There are many who experience adversity for whom the presence of protective factors mitigates the risk. However, for many there is potential for the impact of a trauma to last a lifetime and for it to be transmitted intergenerationally, particularly when we fail to provide appropriate responses.

The cost of trauma is huge and it includes harm to oneself and others. Data analysed in the US for 2018 estimated the cost of post-traumatic stress disorder at over $232 billion. In the UK, a conservative estimate was £14,780 per person. We do not know the true cost but what we do know is that the burden on individuals, families and societies is high.

Examples of protective factors that mitigate risk are socioeconomic status and service access. We can look to addiction for an example. Not all addiction is caused by trauma but research shows that between 60% and 80% of people who have a substance use disorder have experienced trauma. The health research board has identified that those in the lowest and the highest socioeconomic groups use equal amounts of drugs; however, people with a lower socioeconomic status experience a wider range of harms associated with that use. A recent case study example highlights how money is a protective factor. The waiting lists for addiction treatment are long and there are many hoops to jump through, such as the provision of drug-free urine. However, if a person has the ability to pay for the treatment, these barriers do not exist.

There are solutions that can break cycles of trauma. Individual-level interventions, such as counselling and other trauma therapies, will be discussed by others on today’s panel. These are essential for pathways to recovery, but to truly break cycles of trauma we need system changes such as access to housing, health and education services, youth and community projects, and trauma-sensitive and gender- and culturally appropriate public services. We must consider how we distribute resources. Only 1% of the health budget goes to addiction services and 5.8% to mental health services. This is well short of what is required. It costs approximately €100,000 to keep a person in custody in Ireland. For half that cost, it would be possible to provide residential addiction treatment and allied services. There is a plethora of evidence on the social determinants of health and well-being. By not investing in system changes, we perpetuate trauma cycles, with associated costs continuing to increase.